Therapy Exam 3

Front 1

ASA

Back 1

Decreases thromboxane A2 production which inhibits platelet aggregation.
CBC, Fecal occult blood test

Front 2

Dipyridamole

Back 2

Increases cAMP, 1 cap bid
Inhibits platelet aggregation.

Front 3

Ticlodipine

Back 3

P2Y12 inhibitor - Antiplatelet
Messes up lipids. Causes neutropenia thrombocytopenia, aplastic anemia, TTP (main reason not used).

Front 4

Clopidogrel

Back 4

P2Y12 inhibitor - Antiplatelet
Activated in Liver by 2C19 and 3A.
300 or 600 mg loading dose. 75 mg daily dose.
Rash.
Boxed warning for poor metabolizers (2C19 alleles 4-8, need at least 2 of them)
PPIs 3A4 metabolized statins (atorva, lova, simva). CCB's inhibit 3A4, preventing aggregation, same with Ketoconazole.

Front 5

Prasugrel

Back 5

P2Y12 inhibitor activated in liver by 3A, 2B6, 2C9
Boxed warning for bleeding.
Faster onset than clop.
Avoid in patients >75, unless they have DM or prior MI. No patients with h/o TIA and active bleeding. Strong 3A4 inhibitors decrease effectiveness.

Front 6

Ticragelor

Back 6

REVERSIBLE, NONCOMPETITIVE P2Y12 inhibitor
Boxed warning for bleeding. Dyspnea, increased SCr, Afib, Hyperuricemia.
Avoid ASA > 100mg. 3A4 inducers and inhibitors.
Avoid Lova and Simva > 40 mg.
Increases digoxin levels

Front 7

Abciximab

Back 7

Glycoprotein IIb/IIIa inhibitor. Prevents aggregation.
Only given IV in hospital.
Causes thrombocytopenia

Front 8

Tirofiban

Back 8

Glycoprotein IIb/IIIa inhibitor. Prevents aggregation.
Only given IV in hospital.
Causes thrombocytopenia

Front 9

Eptifibatide

Back 9

Glycoprotein IIb/IIIa inhibitor. Prevents aggregation.
Only given IV in hospital.
Causes thrombocytopenia

Front 10

Warfarin

Back 10

Bleeding complications, teratogenicity, skin necrosis, hematomas, purple toe syndrome.
Takes 8-15 days for effect.
Evil A's (amiodarone, antibiotics, antifungals, antiepileptics) increase INR.
Cholestyramine and rifampin inhibit VKA.

Front 11

Dabigatran

Back 11

Direct thrombin inhibitor. Prodrug independent of CYP.
Dose adjusted for CrCl.
GI issues, more bleeding than warfarin.
No routine lab monitoring.
Must store in original container!
Avoid with PGP inducers (rifampin) and inhibitors (dronederone, ketoconazole)

Front 12

Rivaroxaban

Back 12

Reversible, Competitive Xa factor
NOT for ACS.
Risk of spinal/epidural hematoma with surgeries.
N/V/Constipation
Does not require monitoring, has no antidote.
DO NOT use in pregnancy.

Front 13

Apixaban

Back 13

Direct, reversible Xa inhibitor. Inhibits both free and clot associated xa.
Dose adjust for old, skinny, high SCr.
No routine monitoring. No standard antidote (activated charcoal?).
PGP and 3A4 inhibitors.

Front 14

UFH

Back 14

Interacts with lysine site of ATIII (antithrombin). Heparin, ATIII complex inactivates thrombin, Xa, Ixa XIa, XIIa.
HIT, Osteoporosis.
Poor F at low doses. Short t1/2

Front 15

LWMH

Back 15

Binds less to plasma protein and cells.
Coag monitoring unnecessary
Decreased HIT, Decreased osteoporosis.
T1/2 is dose independent

Front 16

Enoxaparin

Back 16

LMWH

Front 17

Fondaparinux

Back 17

Antithrombin inhibition. Can't inhibit thrombin directly. Can't dissolve already formed clots.
Don't use in CrCl <30

Front 18

Cilostazol

Back 18

PDE3I. Inhibits platelet aggregation and causes vasodilation.
Used for intermitten claudication.
HA, Diarrhea, Dizziness, Palpitations.
Take 30 minutes before meals or 2 hours after.
Takes 3-6 months for benefit.
3A4 and 2C9 metabolized.
Avoid in HF

Front 19

Pentoxifylline

Back 19

Relaxes smooth muscle, causing vasodilation.
For intermittent claudication. CHEST suggests against use.
N/V
Only about 20% of patients improve, takes 2-3 months to determine.

Front 20

Alteplase

Back 20

Fibrin Specific fibronlytic.

Front 21

Reteplase

Back 21

Fibrin Specific fibronlytic.

Front 22

Tenecteplase

Back 22

Fibrin Specific fibronlytic.
Most fibrin specific. Only requires single bolus.
Lots of worry about ICH.

Front 23

HIT Treatment

Back 23

Lepirudin, Argatroban, Bivalirudin, Fondaparinux

Seperate lecture: Cilostazol (or maybe pentoxifylline)

Front 24

ABCDEF

Back 24

Anti-platelets, anti-anginals, ACEI
BB, BP
Cholesterol, Cigs
Diet, Diabetes, Depression
Exercise, Education
Flu vaccine, Fish Oil

Front 25

Anti-Anginals

Back 25

BB > CCB > Nitrates > Ranolazine

Front 26

Wall + Artery?

Back 26

Anterior Wall = RAD
Lateral = Left circumflex
Inferior (right) = RCA
Posterior = Left circumflex and RCA

Front 27

When not to use BB in ACS

Back 27

HR < 60
PR Interval > 0.24
SBP < 80

Front 28

Heparin Bleeding Antidote

Back 28

Protamine Sulfate